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During the tour of the Emergency Department and review of the Emergency Equipment logs, it was determined that on the following dates January, 3,4,6,7,8, 10,14, 15, 16, 18,19,20,21,22,23,24,26,27,29,and 30 of January 2014, Emergency Department (ED) staff assigned to check the emergency equipment (Code Carts) failed to sign and validate the emergency equipment checklist to authenticate that the equipment was ready for patient use in an emergent situation.
Review of the hospital's policy/procedure "Emergency Equipment Checklist " indicates that equipment will be inspected and the inspection documented at the beginning of each shift by licensed personnel and that a checklist is signed off by staff performing the inspection.

In addition, on the day of the survey the difficult airway box, which is a part of the emergency equipment in the Trauma Bays was found unsecured (unlocked) and had never been added to the emergency equipment checklist to be inspected and signed off validating that it was ready for use in an emergent patient situation.

Based on review of the Emergency Department Log, it was determined that 4 out of 42 medical record reviews revealed that the hospital failed to date, time portions of a medical record and failed to retain one page of a transfer record.

Patient #5 was transferred to Children' hospital for specialized care. The first page of the transfer record lacked the accepting physicians telephone contact, time of patient assessment prior to departure, time of departure and patient's condition at time of departure.

Patient #6 was transferred to Winchester Medical Center for specialized care. The patient's medical record is incomplete since the first page of the transfer record is missing, which includes the risk and benefits of transfer, in addition, the physician did not complete the section requiring his telephone, address, time of patient departure and the patient's condition at transfer.

Patient #9 was transferred to the University of Maryland Medical Center for specialized care. The patient's transfer record included many blank areas on the form such as ED physician, accepting physician telephone contact, transferring physician's telephone contact and address, departure time from the hospital and patient's condition at departure.

Patient #14 left the hospital against medical advice. The form was signed by the patient and physician but no date or time documented opposite of the patient or physician signature.

Based on review of Emergency Department Log, it was determined that 4 out of 42 medical record reviews revealed that the hospital had failed to properly execute informed consent forms for patients #5, #6, #9 and #21 for transfer.

Patient #5 was transferred to a Children's Hospital for treatment of seizures. The patient consent form was incomplete. The transferring physician failed to complete the form regarding the reason for transfer and to complete the section regarding the relationship of the person signing the form for the patient.

Patient #6 was transferred to Winchester Medical Center but the consent form was incomplete. The transferring physician failed to fill in his/her name and the reason for the transfer.

Patient #9 was transferred to University of Maryland Medical Center but the consent form was incomplete. The name of the hospital the patient agreed to be transferred to was not on the form and the reason for the transfer.

Patient #21 was transferred to Ruby Memorial but the consent form was incomplete. The transferring physician failed to fill in his/her name and the reason for the transfer.

The hospital's consent form for transfer to another hospital contains all the elements of a properly executed informed consent. In 4 out of 30 medical records the transferring physicians did not complete all necessary sections of the consent including key elements like the reason for the transfer.